Individual
PATRICK DONOVAN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2160 S 1ST AVE, LOYOLA UNIVERSITY MEDICAL CENTER, MAYWOOD, IL 60153-3328
(708) 216-9000
(708) 327-3489
Mailing address
2160 S 1ST AVE, LOYOLA UNIVERSITY MEDICAL CENTER, MAYWOOD, IL 60153-3328
(708) 216-9000
(708) 327-3489
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
018001831
IL
Other
Enumeration date
04/02/2012
Last updated
07/02/2012
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